Safety and Feasibility of a Rapid Outpatient Management Strategy for Transient Ischemic Attack and Minor Stroke: The Rapid Access Vascular Evaluation–Neurology (RAVEN) Approach

Rostanski, Sara; Willey, Joshua Z.; Miller, Eliza C.; Shapiro, Steven D.; Mehendale, Rachel; Kummer, Benjamin; Navi, Babak B.; Elkind, Mitchell S.V.

doi:10.1016/j.annemergmed.2019.05.025

Cited by 26 publications

(48 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Five centres with clinics (31%) adopted a different vascular imaging strategy. 3 , 14 , 15 , 16 , 17 …”

Section: Resultsmentioning

confidence: 99%

“…The centres in Melbourne, 14 Oxford, 3 Ottawa, 15 Glasgow 16 and New York 17 have largely replaced carotid ultrasonography with computed tomography angiogram (CTA). Mayo, 18 New York, 17 Paris, 4 and Stanford 19 also reported additional imaging variations. At Mayo, 18 for a short period in late March and April 2020, cardiac CT and transthoracic echocardiogram were used as short-term replacement for transoesophageal echocardiography (TEE) to lessen use of personal protective equipment (PPE) given that TEE is an aerosol generating procedure.…”

Section: Resultsmentioning

confidence: 99%

“…The practice has now returned to use of TEE with appropriate PPE use. New York 17 additionally performs an MRI brain in the ED, as clinically indicated, if follow-up is considered unlikely. The SOS-TIA France model allowed patients to their TIA clinic.…”

Section: Resultsmentioning

confidence: 99%

“…Five centres replaced carotid ultrasonography with CT angiography. 3 , 14 , 15 , 16 , 17 These changes are not without precedents as eleven centres had already been performing CTA as a vascular imaging option in the pre-COVID era. 11 , 12 , 15 , 16 , 21 , 22 , 24 , 32 , 33 , 34 , 35 The changes in strategies may reflect the impracticality of bringing patients back for carotid ultrasound as a separate investigation.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

An International Report on the Adaptations of Rapid Transient Ischaemic Attack Pathways During the COVID-19 Pandemic

Lim

Singhal

Lavallée³

et al. 2020

Journal of Stroke and Cerebrovascular Diseases

Self Cite

View full text Add to dashboard Cite

Background This report aims to describe changes that centres providing transient ischaemic attack (TIA) pathway services have made to stay operational in response to the SARS-CoV-2 pandemic . Methods An international cross-sectional description of the adaptions of TIA pathways between 30 th March and 6 th May 2020. Experience was reported from 18 centres with rapid TIA pathways in seven countries (Australia, France, UK, Canada, USA, New Zealand, Italy, Canada) from three continents. Results All pathways remained active (n = 18). Sixteen (89%) had TIA clinics. Six of these clinics (38%) continued to provide in-person assessment while the majority (63%) used telehealth exclusively. Of these, three reported PPE use and three did not. Five centres with clinics (31%) had adopted a different vascular imaging strategy. Conclusion The COVID pandemic has led TIA clinics around the world to adapt and move to the use of telemedicine for outpatient clinic review and modified investigation pathways. Despite the pandemic, all have remained operational.

show abstract

“…Five centres with clinics (31%) adopted a different vascular imaging strategy. 3 , 14 , 15 , 16 , 17 …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

An International Report on the Adaptations of Rapid Transient Ischaemic Attack Pathways During the COVID-19 Pandemic

Lim

Singhal

Lavallée³

et al. 2020

Journal of Stroke and Cerebrovascular Diseases

Self Cite

View full text Add to dashboard Cite

show abstract

“…Existing evidence suggests that there is clinical equipoise for evaluating suspected TIAMS using an outpatient or inpatient strategy 2. Experience in the USA and other countries suggests an expedited outpatient evaluation can be safe and feasible 3 4…”

Section: Introductionmentioning

confidence: 99%

Are patients afraid to go home? Disposition preferences after transient ischaemic attack and minor stroke

et al. 2020

Self Cite

View full text Add to dashboard Cite

BackgroundRecent evidence suggests clinical equipoise for managing transient ischaemic attack and minor stroke (TIAMS) either via discharge from the emergency department (ED) with rapid outpatient follow-up or inpatient admission. Understanding patient preferences may guide decision-making around disposition after TIAMS that can lead to higher patient satisfaction and adherence. Psychological distress, particularly a sense of vulnerability (eg, ‘threat perception’) is associated with adverse psychological outcomes following TIAMS and may influence patient disposition preference. We hypothesised patients with higher threat perceptions in the ED would prefer inpatient admission versus early discharge with rapid outpatient follow-up.MethodsThis was a planned secondary analysis of a prospective observational cohort study of ED patients with suspected TIAMS (defined as National Institutes of Health Stroke Scale (NIHSS) score of ≤5). Patients reported disposition preferences and completed a validated scale of threat perception while in the ED (score range: 1–4).Results147 TIAMS patients were evaluated (mean age: 59.7±15.4, 45.6% female, 39.5% Hispanic, median NIHSS=1, IQR: 0, 3). A majority of patients (98, 66.7%) preferred inpatient admission compared with discharge from the ED. Overall threat scores were median 1.0 (IQR: 0.43, 1.68). Those preferring admission had similar threat scores compared with those who preferred early disposition (median: 1.00, IQR: 0.43, 1.57) versus 1.00, (IQR: 0.49, 1.68); p=0.40). In a model adjusted for demographic characteristics, threat perceptions remained unassociated with disposition preference.ConclusionOverall, two-thirds of TIAMS patients preferred inpatient admission over discharge. Disposition preference was not associated with higher threat perception in the ED. Further research examining potential drivers of patient disposition preferences may inform patient discussions and optimise patient satisfaction.

show abstract

Risk of Subsequent Stroke Among Patients Receiving Outpatient vs Inpatient Care for Transient Ischemic Attack

et al. 2022

View full text Add to dashboard Cite

show abstract

Safety and Feasibility of a Rapid Outpatient Management Strategy for Transient Ischemic Attack and Minor Stroke: The Rapid Access Vascular Evaluation–Neurology (RAVEN) Approach

Cited by 26 publications

References 38 publications

An International Report on the Adaptations of Rapid Transient Ischaemic Attack Pathways During the COVID-19 Pandemic

An International Report on the Adaptations of Rapid Transient Ischaemic Attack Pathways During the COVID-19 Pandemic

Are patients afraid to go home? Disposition preferences after transient ischaemic attack and minor stroke

Risk of Subsequent Stroke Among Patients Receiving Outpatient vs Inpatient Care for Transient Ischemic Attack

Contact Info

Product

Resources

About